Shirah Vollmer MD

The Musings of Dr. Vollmer


Posted by Dr. Vollmer on May 12, 2016

DSM 5 has added Non-suicidal Self Injury Disorder (NSSID) as a new diagnosis for those who cut on themselves without the intention of dying. Should I rant about this? Of course. Cutting behavior is a symptom of psychic distress, not a diagnosis, per se. The issue is what is the meaning of the cutting? Self-soothing? Attention-seeking? Feelings of helplessness in that there are few other options, or feelings of empowerment because now the person has turned passive feelings of despair into active feelings of anger? As with all symptoms, the puzzle begins, with the task of the professional to try to understand the broader context of this behavior. The act of cutting does not communicate the essence of the patient’s struggle, only that some sort of struggle is going on. This is the difference between a symptom and a diagnosis. A diagnosis is an answer and a symptom starts the questioning. As with so much of psychiatry these days, the confusion between symptom and diagnosis is disturbing. Once a diagnosis is made, questioning often stops, and treatment begins. With NSSID, this should start the inquiry, and not lead to quick labeling and a certainty of a mental illness which underlies the behavior. Mental distress does not equal mental illness. DSM 5 gets that all wrong. End of rant, at least for now.

4 Responses to “NSSID”

  1. Shelly said

    Can people ‘outgrow’ their disorder? When they stop feeling their distress, does the label go away? If they are on medication and stop, does it mean that they never were sick? Does it make the psychiatrist doubt the diagnosis?

    • DSM 5 calls it a disorder. I call it a symptom, which is very different. DSM 5 would say the disorder can go away. They do not categorize it as a developmental disorder, so they do not see it as “outgrowing”. If the medication causes the behavior to stop, DSM 5 would say it is a treatment success. I would say that it is not a success unless the meaning of the cutting is understood. I, as a psychiatrist, find the diagnosis misleading and unhelpful to patients. I think that if we identified it as a symptom, which required further exploration, we would be in better shape. Thanks, as always, and have a good weekend.

  2. I’m not really familiar with diagnoses when somebody is suicidal. I know it can be part of depression, but I think it can be so much more. I kind of like this new diagnosis….I know it’s a symptom, I get that…but I had a therapist one time report that I had suicidal ideation because I engaged in self-harm. I was never suicidal. It was a release to cut or burn myself, but I wasn’t looking to be dead.

    • Hello Pattyspathtohealing…thank you for chiming in. You raise an important point that self-soothing is a far cry from self-hating and sometimes they get confused. Thanks Again.

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